North American and European leaders update pandemic plans

Apr 4, 2012 (CIDRAP News) – Armed with lessons learned during the 2009 H1N1 pandemic, government leaders in North America and Europe this week launched new guidance aimed at boosting preparedness for the next influenza pandemic.

On Apr 2, the heads of Canada, Mexico, and the United States unveiled a new "North American Plan for Animal and Pandemic Influenza" at the North American Leader's Summit in Washington, D.C. And health officials in Europe today released a report on key changes to pandemic plans that European countries are considering based on lessons learned during the 2009 pandemic.

The North American plan for the first time extends pandemic planning framework to a broad range of sectors, including health, agriculture, security, and foreign affairs, the US Department of Health and Human Services (HHS) said in a press release. "Collaboration among these partners is vital for a faster response to pandemic threats," the agency said.

The 78-page plan describes how the countries will develop and implement actions to strengthen trilateral response capabilities, including surveillance and early warning of disease outbreaks and protocols for transporting laboratory samples. HHS said Canada, Mexico, and the United States also agree to conduct joint epidemiologic investigations of viruses that have pandemic potential, including animal influenza outbreaks that pose zoonotic disease threats.

The HHS office of the Assistant Secretary for Preparedness and Response led the US efforts to develop the plan, which included a host of other US government departments and their counterparts in Canada and Mexico. HHS said the plan builds on a 2007 plan as well as on newer efforts announced at the 2009 leader's summit, which came about 5 months into the pandemic.

Nicole Lurie, MD, HHS assistant secretary for preparedness and response, said in the statement, "H1N1 provided a stern reminder that diseases don't respect national borders and can spread rapidly in our interconnected world, so protecting health requires cooperation and collaboration among countries."

The plan recognizes spotty surveillance and lack of reporting of influenza in animals other than poultry, especially ones such as swine in which influenza strains can have zoonotic potential.

According to the plan, the three countries will work together and with international organizations to develop guidance for influenza surveillance systems for select animal species, as well as guidance on the characterization, case definition, and reporting of novel strains, and on triggers for public health response

Another issue the plan tackles is how to improve procedures to facilitate the cross-border transport of specimens and isolates among the countries before and during a pandemic.

Regarding countermeasures, some of the plan's steps include exploring new financing and procurement mechanisms, investments in new and more flexible technology and manufacturing platforms, and coordinating plans for preparedness exercises. The plan also touches on sharing best practices for stockpiling.

The countries agreed to explore how to identify legal and regulatory challenges for helping each other with personnel and medical countermeasures in a public health emergency. The plan includes the establishment of liaisons from key government agencies to assist with communications between countries on policy discussions, emergency operations, and sharing surveillance and epidemiologic data.

The new plan addresses border issues, with a strong emphasis on interdependence between the three countries and the need to protect infrastructure and the flow of trade among them.

While recognizing that countries have a sovereign right to control their borders, the agreement says highly restrictive measures might delay but not stop the spread of a novel flu strain within North America. It notes that less restrictive measures, such as passenger screening, might slow the spread of the virus with fewer negative consequences.

The countries said they will establish a trilateral working group on border measures to review current regulations and improve cooperation.

European lessons learnedMeanwhile, several European countries are in the process of revising their pandemic plans, based on the lessons they learned during the 2009 H1N1 pandemic.

The European Centre for Disease Prevention and Control (ECDC) today published findings from a series of four pandemic preparedness workshops that it sponsored in September and November 2011 along with the World Health Organization's (WHO's) Regional Office for Europe. The ECDC said the goals of the workshops was to learn what key changes countries were making and facilitate sharing lessons they've learned.

According to the report, 28 European member countries have evaluated their pandemic response, and 12 assessments have been posted on national government Web sites. Also, 32 more countries said they were in the process of revising their plans, and two have posted their revised versions.

Some of the areas where key changes were made or are being considered include flexibility of plans, strategies for vaccines and antivirals, and strategies for sharing information.

Changes in the pandemic plans will likely include a range of planning scenarios, not just a severe one. New policies are likely to include response triggers that are not based on WHO pandemic phase declarations, a practice that sparked controversy in some countries during the pandemic.

The 16-page report acknowledges the difficulties many countries had procuring, delivering, and communicating about vaccines and antivirals, which led to drops in public confidence in some countries. It also addresses the need for more flexible vaccine contracts, another hot-button issue during the pandemic, and the possibility that countries or groups of countries could team up on pandemic procurement contracts.

The need for better surveillance and monitoring of countermeasure use was also detailed in the report. For example, it said better systems for assessing severe disease patterns in hospitals could help more accurately gauge disease burden and better inform risk assessments.